1
|
Jarab AS, Al-Qerem WA, Hamam HW, Alzoubi KH, Abu Heshmeh SR, Mukattash TL, Alefishat E. Medication Adherence and Its Associated Factors Among Outpatients with Heart Failure. Patient Prefer Adherence 2023; 17:1209-1220. [PMID: 37187575 PMCID: PMC10178996 DOI: 10.2147/ppa.s410371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
Background Poor adherence to heart failure (HF) medications represents a major barrier to achieve the desired health outcomes in those patients. Objective To assess medication adherence and to explore the factors associated with medication non-adherence among patient with HF in Jordan. Methods The current cross-sectional study was conducted at the outpatient cardiology clinics at two main hospitals in Jordan from August 2021 through April 2022. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale. Multinomial logistic regression analysis was performed to identify the factors that are significantly and independently associated with medication non-adherence. Results Of the 427 participating patients, 92.5% had low to moderate medication adherence. Results of the regression analysis revealed that that patients who had higher education level (OR=3.36; 95% CI 1.08-10.43; P=0.04) and were not suffering from medication-related side effects (OR=4.7; 95% CI 1.91-11.5; P=0.001) had significantly higher odds of being in the moderate adherence group. Patients who were taking statins (OR=16.59; 95% CI 1.79-153.98; P=0.01) or ACEIs/ ARBs (OR=3.95; 95% CI 1.01-15.41; P=0.04) had significantly higher odds of being in the high adherence group. Furthermore, Patients who were not taking anticoagulants had higher odds of being in the moderate (OR=2.77; 95% CI 1.2-6.46; P=0.02) and high (OR=4.11; 95% CI 1.27-13.36; P=0.02) adherence groups when compared to patients who were taking anticoagulants. Conclusion The poor medication adherence in the present study sheds the light on the importance of implementing intervention programs which focus on improving patients' perception about the prescribed medications particularly for patients who have low educational levels, receive an anticoagulant, and do not receive a statin or an ACEI/ ARB.
Collapse
Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Walid A Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, 11733, Jordan
| | - Hanan Walid Hamam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, 11942, Jordan
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
- Correspondence: Eman Alefishat, Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates, Tel +971 5 07293877, Email
| |
Collapse
|
2
|
Di Filippo A, Perna S, Pierantozzi A, Milozzi F, Fortinguerra F, Caranci N, Moro L, Agabiti N, Belleudi V, Cesaroni G, Nardi A, Spadea T, Gnavi R, Trotta F. Socio-economic inequalities in the use of drugs for the treatment of chronic diseases in Italy. Int J Equity Health 2022; 21:157. [DOI: 10.1186/s12939-022-01772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Since the use of medicines is strongly correlated to population health needs, higher drug consumption is expected in socio-economical deprived areas. However, no systematic study investigated the relationship between medications use in the treatment of chronic diseases and the socioeconomic position of patients. The purpose of the study is to provide a description, both at national level and with geographical detail, of the use of medicines, in terms of consumption, adherence and persistence, for the treatment of major chronic diseases in groups of population with different level of socioeconomic position.
Methods
A cross-sectional study design was used to define the “prevalent” users during 2018. A longitudinal cohort study design was performed for each chronic disease in new drug users, in 2018 and the following year. A retrospective population-based study, considering all adult Italian residents (i.e. around 50.7 million people aged ≥ 18 years). Different medications were used as a proxy for underlying chronic diseases: hypertension, dyslipidemia, osteoporosis, diabetes and chronic obstructive pulmonary disease. Only “chronic” patients who had at least 2 prescriptions within the same subgroup of drugs or specific medications during the year were selected for the analysis. A multidimensional measures of socio-economic position, declined in a national deprivation index at the municipality level, was used to identify and estimate the relationship with drug use indicators. The medicine consumption rate for each pharmacological category was estimated for prevalent users while adherence and persistence to pharmacologic therapy at 12 months were evaluated for new users.
Results
The results highlighted how the socioeconomic deprivation is strongly correlated with the use of medicines: after adjustment by deprivation index, the drug consumption rates decreased, mainly in the most disadvantaged areas, where consumption levels are on average higher than in other areas. On the other hand, the adherence and persistence indicators did not show the same trend.
Conclusions
This study showed that drug consumption is influenced by the level of deprivation consistently with the distribution of diseases. For this reason, the main levers on which it is necessary to act to reduce disparities in health status are mainly related to prevention. Moreover, it is worth pointing out that the use of a municipal deprivation indicator necessarily generates an ecological bias, however, the experience of the present study, which for the first-time deals with the complex and delicate issue of equity in Italian pharmaceutical assistance, sets the stage for new insights that could overcome the limits.
Collapse
|
3
|
Soldati S, Di Martino M, Rosa AC, Fusco D, Davoli M, Mureddu GF. The impact of in-hospital cardiac rehabilitation program on medication adherence and clinical outcomes in patients with acute myocardial infarction in the Lazio region of Italy. BMC Cardiovasc Disord 2021; 21:466. [PMID: 34565326 PMCID: PMC8474767 DOI: 10.1186/s12872-021-02261-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Medication adherence is a recognized key factor of secondary cardiovascular disease prevention. Cardiac rehabilitation increases medication adherence and adherence to lifestyle changes. This study aimed to evaluate the impact of in-hospital cardiac rehabilitation (IH-CR) on medication adherence as well as other cardiovascular outcomes, following an acute myocardial infarction (AMI). Methods This is a population-based study. Data were obtained from the Health Information Systems of the Lazio Region, Italy (5 million inhabitants). Hospitalized patients aged ≥ 18 years with an incident AMI in 2013–2015 were investigated. We divided the whole cohort into 4 groups of patients: ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) who underwent or not percutaneous coronary intervention (PCI) during the hospitalization. Primary outcome was medication adherence. Adherence to chronic poly-therapy, based on prescription claims for both 6- and 12-month follow-up, was defined as Medication Possession Ratio (MPR) ≥ 75% to at least 3 of the following medications: antiplatelets, β-blockers, ACEI/ARBs, statins. Secondary outcomes were all-cause mortality, hospital readmission for cardiovascular and cerebrovascular event (MACCE), and admission to the emergency department (ED) occurring within a 3-year follow-up period. Results A total of 13.540 patients were enrolled. The median age was 67 years, 4.552 (34%) patients were female. Among the entire cohort, 1.101 (8%) patients attended IH-CR at 33 regional sites. Relevant differences were observed among the 4 groups previously identified (from 3 to 17%). A strong association between the IH-CR participation and medication adherence was observed among AMI patients who did not undergo PCI, for both 6- and 12-month follow-up. Moreover, NSTEMI-NO-PCI participants had lower risk of all-cause mortality (adjusted IRR 0.76; 95% CI 0.60–0.95), hospital readmission due to MACCE (IRR 0.78; 95% CI 0.65–0.94) and admission to the ED (IRR 0.80; 95% CI 0.70–0.91). Conclusions Our findings highlight the benefits of IH-CR and support clinical guidelines that consider CR an integral part in the treatment of coronary artery disease. However, IH-CR participation was extremely low, suggesting the need to identify and correct the barriers to CR participation for this higher-risk group of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02261-6.
Collapse
Affiliation(s)
- Salvatore Soldati
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
| | | | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | |
Collapse
|
4
|
Harvey NC, Lorentzon M, Kanis JA, McCloskey E, Johansson H. Incidence of myocardial infarction and associated mortality varies by latitude and season: findings from a Swedish Registry Study. J Public Health (Oxf) 2021; 42:e440-e448. [PMID: 31774530 DOI: 10.1093/pubmed/fdz131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We investigated whether the incidence of death following myocardial infarction (MI) varied by season and latitude in the Swedish population. METHODS We studied deaths following MI from January 1987 to December 2009, using the Swedish National Cause of Death Register. County of residence was used to determine latitude and population density. An extension of Poisson regression was used to study the relationship between risk of death following MI with age, latitude, time (from 1987), population density and calendar days. RESULTS Over the study period, there was a secular decrease in the incidence of MI-related death. In men, MI-related death incidence increased by 1.3% [95% confidence interval (CI) = 1.1-1.5] per degree of latitude (northwards). In women, MI-related death incidence increased by 0.6% (95% CI = 0.4-0.9) per degree of latitude. There was seasonal variation in the risk of MI-related death with peak values in the late winter and a nadir in the summer months in both the north and the south of Sweden. Findings were similar with incident MI as the outcome. CONCLUSIONS The incidence of MI-related death varied markedly by season and latitude in Sweden, with summer months and more southerly latitude associated with lower rates than winter months and more northerly latitude.
Collapse
Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Mattias Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden.,Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.,Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.,Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.,Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| |
Collapse
|
5
|
Di Martino M, Alagna M, Lallo A, Gilmore KJ, Francesconi P, Profili F, Scondotto S, Fantaci G, Trifirò G, Isgrò V, Davoli M, Fusco D. Chronic polytherapy after myocardial infarction: the trade-off between hospital and community-based providers in determining adherence to medication. BMC Cardiovasc Disord 2021; 21:180. [PMID: 33853534 PMCID: PMC8048349 DOI: 10.1186/s12872-021-01969-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background The benefits of chronic polytherapy in reducing readmissions and death after myocardial infarction (MI) have been clearly shown. However, real-world evidence shows poor medication adherence and large geographic variation, suggesting critical issues in access to optimal care. Our objectives were to measure adherence to polytherapy, to compare the amount of variation attributable to hospitals of discharge and to community-based providers, and to identify determinants of adherence to medications. Methods This is a population-based study. Data were obtained from the information systems of the Lazio and Tuscany Regions, Italy (9.5 million inhabitants). Patients hospitalized with incident MI in 2010–2014 were analyzed. The outcome measure was medication adherence, defined as a Medication Possession Ratio (MPR) ≥ 0.75 for at least 3 of the following drugs: antiplatelets, β-blockers, ACEI/ARBs, statins. A 2-year cohort-study was performed. Cross-classified multilevel models were applied to analyze geographic variation. The variance components attributable to hospitals of discharge and community-based providers were expressed as Median Odds Ratio (MOR). Results A total of 32,962 patients were enrolled. About 63% of patients in the Lazio cohort and 59% of the Tuscan cohort were adherent to chronic polytherapy. Women and patients aged 85 years and over were most at risk of non-adherence. In both regions, adherence was higher for patients discharged from cardiology wards (Lazio: OR = 1.58, p < 0.001, Tuscany: OR = 1.59, p < 0.001) and for patients with a percutaneous coronary intervention during the index admission. Relevant variation between community-based providers was observed, though when the hospital of discharge was included as a cross-classified level, in both Lazio and Tuscany regions the variation attributable to hospitals of discharge was the only significant component (Lazio: MOR = 1.30, p = 0.001; Tuscany: MOR = 1.31, p = 0.001). Conclusion Adherence to best practice treatments after MI is not consistent with clinical guidelines, and varies between patient groups as well as within and between regions. The variation attributable to providers is affected by the hospital of discharge, up to two years from the acute episode. This variation is likely to be attributable to hospital discharge processes, and could be reduced through appropriate policy levers. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01969-9.
Collapse
Affiliation(s)
- Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy.
| | - Michela Alagna
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Adele Lallo
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | | | - Paolo Francesconi
- Epidemiology Unit, Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Francesco Profili
- Epidemiology Unit, Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Giovanna Fantaci
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Valentina Isgrò
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| |
Collapse
|
6
|
Soldati S, Di Martino M, Castagno D, Davoli M, Fusco D. In-hospital myocardial infarction and adherence to evidence-based drug therapies: a real-world evaluation. BMJ Open 2021; 11:e042878. [PMID: 33550255 PMCID: PMC7925929 DOI: 10.1136/bmjopen-2020-042878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aimed to measure adherence to chronic polytherapy following an acute myocardial infarction (AMI) and to find out associations between adherence and the setting of AMI onset (in vs out of hospital) as well as other determinants. DESIGN Retrospective follow-up study. SETTING Population living in the Lazio Region, Italy. PARTICIPANTS This study included 25 779 hospitalised patients with a first diagnosis of AMI in 2012-2016, after the exclusion of those with hospital admission for AMI or related causes in the previous 5 years. PRIMARY AND SECONDARY OUTCOME MEASURES Patients were classified as in-hospital AMI (IH-AMI) or out of hospital AMI (OH-AMI) according to present-on-admission codes. Adherence was measured based on prescription claims during a 6-month follow-up after hospital discharge, using medication possession ratio (MPR). Adherence to chronic polytherapy was defined as MPR ≥75% to at least 3 of the following medications: antithrombotics, betablockers, ACE inhibitors/angiotensin receptor blockers and statins. RESULTS Among the entire cohort, 1 044 (4%) patients suffered IH-AMI. Overall, 15 440 (60%) patients were deemed adherent to chronic polytherapy. Female gender, older age, mental disorders, renal disease, asthma and ongoing concomitant treatments were factors associated with poor adherence. By contrast, patients with more severe AMI and those already taking evidence-based (E-B) drugs were more likely to be adherent. A strong association between the setting of AMI onset and adherence was observed: IH-AMI patients were 46% less likely to be adherent to E-B medications during their 6-month follow-up as compared with OH-AMI patients (OR 0.54; 95% CI 0.47 to 0.62; p<0.001). CONCLUSION Pharmacotherapy is not consistent with clinical guidelines, especially for IH-AMI patients. Our findings provide evidence on a previously unidentified groups of patients at risk for poor adherence, who might benefit from greater medical attention and dedicated healthcare interventions.
Collapse
Affiliation(s)
- Salvatore Soldati
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| |
Collapse
|
7
|
Barker KM, Dunn EC, Richmond TK, Ahmed S, Hawrilenko M, Evans CR. Cross-classified multilevel models (CCMM) in health research: A systematic review of published empirical studies and recommendations for best practices. SSM Popul Health 2020; 12:100661. [PMID: 32964097 PMCID: PMC7490849 DOI: 10.1016/j.ssmph.2020.100661] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022] Open
Abstract
Recognizing that health outcomes are influenced by and occur within multiple social and physical contexts, researchers have used multilevel modeling techniques for decades to analyze hierarchical or nested data. Cross-Classified Multilevel Models (CCMM) are a statistical technique proposed in the 1990s that extend standard multilevel modeling and enable the simultaneous analysis of non-nested multilevel data. Though use of CCMM in empirical health studies has become increasingly popular, there has not yet been a review summarizing how CCMM are used in the health literature. To address this gap, we performed a scoping review of empirical health studies using CCMM to: (a) evaluate the extent to which this statistical approach has been adopted; (b) assess the rationale and procedures for using CCMM; and (c) provide concrete recommendations for the future use of CCMM. We identified 118 CCMM papers published in English-language literature between 1994 and 2018. Our results reveal a steady growth in empirical health studies using CCMM to address a wide variety of health outcomes in clustered non-hierarchical data. Health researchers use CCMM primarily for five reasons: (1) to statistically account for non-independence in clustered data structures; out of substantive interest in the variance explained by (2) concurrent contexts, (3) contexts over time, and (4) age-period-cohort effects; and (5) to apply CCMM alongside other techniques within a joint model. We conclude by proposing a set of recommendations for use of CCMM with the aim of improved clarity and standardization of reporting in future research using this statistical approach.
Collapse
Affiliation(s)
- Kathryn M Barker
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Tracy K Richmond
- Department of Medicine, Division of Adolescent Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah Ahmed
- Department of Sociology, University of Oregon, Eugene, OR, USA
| | - Matthew Hawrilenko
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Clare R Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA
| |
Collapse
|
8
|
Ferranti M, Pinnarelli L, Rosa A, Pastorino R, D’Ovidio M, Fusco D, Davoli M. Evaluation of the breast cancer care network within the Lazio Region (Central Italy). PLoS One 2020; 15:e0238562. [PMID: 32881971 PMCID: PMC7470269 DOI: 10.1371/journal.pone.0238562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A summary indicator for evaluating the breast cancer network has never been measured at the regional level. The aim is to design treemaps providing a summary description of hospitals (including breast units) and Local Health Units (LHUs) in terms of their levels of performance within the breast cancer network of the Lazio region (central Italy). The treemap structure has an intuitive design and displays information from both general and specific analyses. METHODS Patients admitted to the regional hospitals for malignant breast cancer (MBC) surgery in 2010-2017 were selected in a population-based cohort study. These quality indicators were calculated based on the international guidelines (EUSOMA, ESMO) to assess the performance in terms of volume of activity, surgery procedure, post-surgery assistance and timeliness of medical therapy or radiotherapy beginning. The quality indicators were calculated using administrative health data systematically collected at the regional level and were included in the treemap to represent the surgery or the post-surgery areas of the breast cancer clinical pathway. In order to allow aggregation of scores for different indicators belonging to the same clinical area, up to five evaluation classes were defined using the "Jenks Natural Breaks" algorithm. A score and a colour were assigned to each clinical area based on the ranking of the indicators involved. The analyses were performed on an annual basis, by the LHU of residence and by the hospital which performed the surgical intervention. RESULTS In 2017, 6218 surgical interventions for MBC were performed in the hospitals of Lazio. The results showed a continuous increase of the level of performance over the years. Hospitals showed higher variability in the levels of performance than the LHUs. 36% of the evaluated hospitals reached a high level of performance. An audit of the S. Filippo Neri breast unit revealed incorrect coding of the input data. For this reason, the score for the indicator for the volume of wards was re-calculated and re-evaluated, with a subsequent improvement of the level of performance. Most LHUs achieved at least an average overall level of performance, with 20% of the LHUs reaching a high level of performance. CONCLUSIONS This is the first attempt to apply the treemap logic to a single clinical network, in order to obtain a summary indicator for the evaluation of the breast cancer care network. Our results supply decision makers with a transparent instrument of governance for heterogeneous users, directing efforts improving and promoting equity of care. The treemaps could be reproduced and adapted for other local contexts, in order to limit inappropriateness and ensure uniform levels of breast cancer care within local areas. The next step is the evaluation of audit and feedback interventions to improve the quality of care and to guarantee homogeneous levels of care throughout the region.
Collapse
Affiliation(s)
- Margherita Ferranti
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- * E-mail:
| | - Luigi Pinnarelli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Alessandro Rosa
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Danilo Fusco
- Lazio Regional Health Service, Department of Health Information Systems, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| |
Collapse
|
9
|
Health Outcomes and Primary Adherence to Secondary Prevention Treatment after St-Elevation Myocardial Infarction: a Spanish Cohort Study. J Cardiovasc Transl Res 2020; 14:308-316. [PMID: 32557320 DOI: 10.1007/s12265-020-10045-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/03/2020] [Indexed: 01/13/2023]
Abstract
This retrospective observational study aimed to establish the first prescription and its dispensation (primary adherence) in the first 30 days of the four pharmacotherapeutic classes recommended after a type 1 STEMI episode, determine the potential risk factors for lack of primary adherence, and evaluate the potential impact of primary adherence on cardiovascular outcomes. Of the 613 patients analyzed, 576 were included (64.7 ± 13.8 years, 73.8% men) between January 2008 and December 2013. Primary adherence exceeded 90% in all groups. Complete primary adherence was higher in high-drug coverage patients and was lower in patients with cardiovascular or neuropsychiatric diseases. According to competing risk analysis, 1-year cardiovascular mortality was significantly lower in patients with complete primary adherence than in those without complete prescription or adherence, 1.8% versus 5.6% (HR = 0.286; p = 0.012). Complete primary adherence did not prevent a 1-year cardiovascular event, 5.6% versus 5.5% (p = 0.904).
Collapse
|
10
|
Goldman JD, Harte FM. Transition of care to prevent recurrence after acute coronary syndrome: the critical role of the primary care provider and pharmacist. Postgrad Med 2020; 132:426-432. [PMID: 32207352 DOI: 10.1080/00325481.2020.1740512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite therapeutic advances, patients with acute coronary syndrome (ACS) are at an increased long-term risk of recurrent cardiovascular events. This risk continues to rise as the number of associated comorbidities, often observed in patients presenting with ACS, increases. Such a level of clinical complexity can lead to gaps in care and subsequently worse outcomes. Guidelines recommend providing an evidence-based post-discharge plan to prevent readmission and recurrent ACS, including cardiac rehabilitation, medication, patient/caregiver education, and ongoing follow-up. A patient-centric multidisciplinary approach is critical for the effective management of the transition of care from acute care in the hospital setting to the outpatient care setting in patients with ACS. Ongoing communication between in-hospital and outpatient healthcare providers ensures that the transition is smooth. Primary care providers and pharmacists have a pivotal role to play in the effective management of transitions of care in patients with ACS. Guideline recommendations regarding the post-discharge care of patients with ACS and the role of the primary care provider and the pharmacist in the management of transitions of care will be reviewed.
Collapse
Affiliation(s)
- Jennifer D Goldman
- Department of Pharmacy Practice, MCPHS University , Boston, MA, USA.,Well Life Medical , Peabody, MA, USA
| | | |
Collapse
|
11
|
Jarab AS, Rababa'h AM, Almousa A, Mukattash TL, Bsoul R. Non‐adherence to pharmacotherapy and its associated factors among patients with angina in Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anan S. Jarab
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| | - Abeer M. Rababa'h
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| | - Abdullah Almousa
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| | - Razan Bsoul
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| |
Collapse
|
12
|
Sakalaki M, Barywani S, Rosengren A, Björck L, Fu M. Determinants of suboptimal long-term secondary prevention of acute myocardial infarction: the structural interview method and physical examinations. BMC Cardiovasc Disord 2019; 19:243. [PMID: 31694556 PMCID: PMC6833166 DOI: 10.1186/s12872-019-1238-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 10/24/2019] [Indexed: 11/19/2022] Open
Abstract
Background Secondary prevention after an acute myocardial infarction (AMI) reduces morbidity and mortality, but suboptimal secondary prevention of cardiovascular disease is common. Therefore, the present study aimed to identify potential underlying factors for suboptimal secondary prevention 2 years after an AMI event. Methods Patients aged 18–85 years at the time of their index AMI and hospitalized between July 2010 and December 2011, were identified retrospectively and consecutively from hospital discharge records. All patients who agreed to participate underwent a structured interview, physical examinations and laboratory analysis 2 years after their index AMI. The secondary preventive goals included are; blood pressure < 140/90 mmHg, LDL < 1.8 mmol/L, HbA1c < 48 mmol/mol, regular physical activity that causes sweating at least twice a week, non-smoking and BMI < 25 kg/m2. Multivariable and univariable logistic regression models were applied to identify independent predictors of different secondary prevention achievements. Results Of the 200 patients (mean age 63.3 ± 9.7 years) included in the study, 159 (80%) were men. No common determinants were found in patients who failed to achieve at least six secondary prevention guideline-directed goals. For individual secondary prevention goals, several determinants were defined. Patients born in Sweden were less likely to achieve optimal lipid control [odds ratio (OR) 0.28 (95% confidence interval, CI 0.12–0.63)]. Younger (≤ 65 years) [OR 0.24 (95% CI 0.07–0.74)] and unemployed patients [OR 0.23 (95% CI 0.06–0.82)] were less likely to be non-smokers. Patients with diabetes mellitus [OR 0.21 (95% CI 0.04–0.98)] or with a walking aid [OR 0.23 (95% CI 0.07–0.71)] were less likely to achieve an optimal body mass index (BMI < 25). Living alone was an independent predictor of achieving regular physical activity [OR 1.94 (95% CI 1.02–3.69)]. Conclusion Long-term secondary prevention remained suboptimal 2 years after an AMI. Causes are likely multifactorial, with no single determinant for all six guideline-recommended preventive goals. Therefore a tailored comprehensive assessment should be requested and updated and treatment of risk factors should be applied.
Collapse
Affiliation(s)
- Maria Sakalaki
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
| | - Salim Barywani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| |
Collapse
|
13
|
Harsha N, Kőrösi L, Pálinkás A, Bíró K, Boruzs K, Ádány R, Sándor J, Czifra Á. Determinants of Primary Nonadherence to Medications Prescribed by General Practitioners Among Adults in Hungary: Cross-Sectional Evaluation of Health Insurance Data. Front Pharmacol 2019; 10:1280. [PMID: 31736757 PMCID: PMC6836763 DOI: 10.3389/fphar.2019.01280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015. Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling. Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1% of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = -0.099, 95%CI = -0.103 to -0.094), higher level of education (b = -0.440, 95%CI = -0.468 to -0.413), and vacancy of the general practices (b = -0.193, 95%CI = -0.204 to -0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well. Conclusions: More than one-third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed-to-prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.
Collapse
Affiliation(s)
- Nouh Harsha
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, Budapest, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Árpád Czifra
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
14
|
Schang L, Koller D, Franke S, Sundmacher L. Exploring the role of hospitals and office-based physicians in timely provision of statins following acute myocardial infarction: a secondary analysis of a nationwide cohort using cross-classified multilevel models. BMJ Open 2019; 9:e030272. [PMID: 31619423 PMCID: PMC6797264 DOI: 10.1136/bmjopen-2019-030272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To examine the role of hospitals and office-based physicians in empirical networks that deliver care to the same population with regard to the timely provision of appropriate care after hospital discharge. DESIGN Secondary data analysis of a nationwide cohort using cross-classified multilevel models. SETTING Transition from hospital to ambulatory care. PARTICIPANTS All patients discharged for acute myocardial infarction (AMI) from Germany's largest statutory health insurance fund group in 2011. MAIN OUTCOME MEASURE Patients' odds of receiving a statin prescription within 30 days after hospital discharge. RESULTS We found significant variation in 30-day statin prescribing between hospitals (median OR (MOR) 1.40; 95% credible interval (CrI) 1.36 to 1.45), hospital-physician pairs caring for the same patients (MOR 1.32; 95% CrI 1.26 to 1.38) and to a lesser extent between physicians (MOR 1.14; 95% CrI 1.11 to 1.19). About 67% of the variance between hospital-physician pairs and about 45% of the variance between hospitals was explained by hospital characteristics including a rural location, teaching status and the number of beds, the number of patients shared between a hospital and an office-based physician as well as 16 patient characteristics, including multimorbidity and dementia. We found no impact of physician characteristics. CONCLUSIONS Timely prescription of appropriate secondary prevention pharmacotherapy after AMI is subject to considerable practice variation which is not consistent with clinical guidelines. Hospitals contribute more to the observed variation than physicians, and most of the variation lies at the patient level. To ensure care continuity for patients, it is important to strengthen hospital capacity for discharge management and coordination between hospitals and office-based physicians.
Collapse
Affiliation(s)
- Laura Schang
- Department of Health Services Management, Ludwig-Maximilians-Universitat München, Munich, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sebastian Franke
- Department of Health Services Management, Ludwig-Maximilians-Universitat München, Munich, Germany
| | - L Sundmacher
- Department of Health Services Management, Ludwig-Maximilians-Universitat München, Munich, Germany
| |
Collapse
|
15
|
Burton C, O'Neill L, Oliver P, Murchie P. Contribution of primary care organisation and specialist care provider to variation in GP referrals for suspected cancer: ecological analysis of national data. BMJ Qual Saf 2019; 29:296-303. [PMID: 31586938 DOI: 10.1136/bmjqs-2019-009469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 07/12/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine how much of the variation between general practices in referral rates and cancer detection rates is attributable to local health services rather than the practices or their populations. DESIGN Ecological analysis of national data on fast-track referrals for suspected cancer from general practices. Data were analysed at the levels of general practice, primary care organisation (Clinical Commissioning Group) and secondary care provider (Acute Hospital Trust) level. Analysis of variation in detection rate was by multilevel linear and Poisson regression. SETTING 6379 group practices with data relating to more than 50 cancer cases diagnosed over the 5 years from 2013 to 2017. OUTCOMES Proportion of observed variation attributable to primary and secondary care organisations in standardised fast-track referral rate and in cancer detection rate before and after adjustment for practice characteristics. RESULTS Primary care organisation accounted for 21% of the variation between general practices in the standardised fast-track referral rate and 42% of the unadjusted variation in cancer detection rate. After adjusting for standardised fast-track referral rate, primary care organisation accounted for 31% of the variation in cancer detection rate (compared with 18% accounted for by practice characteristics). In areas where a hospital trust was the main provider for multiple primary care organisations, hospital trusts accounted for the majority of the variation attributable to local health services (between 63% and 69%). CONCLUSION This is the first large-scale finding that a substantial proportion of the variation between general practitioner practices in referrals is attributable to their local healthcare systems. Efforts to reduce variation need to focus not just on individual practices but on local diagnostic service provision and culture at the interface of primary and secondary care.
Collapse
Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Luke O'Neill
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Phillip Oliver
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
16
|
Forsyth P, Moir L, Speirits I, McGlynn S, Ryan M, Watson A, Reid F, Rush C, Murphy C. Improving medication optimisation in left ventricular systolic dysfunction after acute myocardial infarction. BMJ Open Qual 2019; 8:e000676. [PMID: 31544164 PMCID: PMC6730630 DOI: 10.1136/bmjoq-2019-000676] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 01/09/2023] Open
Abstract
Glasgow city has the highest cardiovascular disease (CVD) mortality rate in the UK. Patients with left ventricular systolic dysfunction after acute myocardial infarction represent a ‘high-risk’ cohort for adverse CVD outcomes. The optimisation of secondary prevention medication in this group is often suboptimal. Our aim was to improve the use and target dosing of ACE inhibitors (ACEI), angiotensin II receptor blockers (ARBs) and beta-blockers in such patients, through pharmacist-led clinics and cardiology multidisciplinary team collaboration. Retrospective audits characterised baseline care. Prospective pharmacist-led clinics were piloted and rolled out across seven hospitals and primary care localities over four Plan–Do–Study–Act cycles. ‘Hub’ and ‘spoke’ clinics utilised independent prescribing pharmacists with different levels of cardiology experience. Pharmacists were trained through a bespoke training programme—‘Teach and Treat’. Consultant cardiologists provided senior support and governance. Patients attending prospective pharmacist-led clinics were more likely to be prescribed an ACEI (or ARB) and beta-blocker (n=856/885 (97%) vs n=233/255 (91%), p<0.001 and n=813/885 (92%) vs n=224/255 (88%), p=0.048, respectively) and be on target dose of ACEI (or ARB) and beta-blocker (n=585/885 (66%) vs n=64/255 (25%), p<0.001 and n=218/885 (25%) vs n=17/255 (7%), p<0.001, respectively) compared with baseline. The mean dose of ACEI (or ARB) and beta-blocker was also higher (79% vs 48% of target dose, p<0.001% and 48% vs 33% of target dose, p<0.001, respectively) compared with baseline. Use of secondary prevention medication was significantly improved by pharmacist and cardiology collaboration. These improvements were sustained across a 4-year period, supported by a novel approach called ‘Teach and Treat’ which linked training to defined clinical service delivery. Further work is needed to assess the impact of the programme on long-term CVD outcomes.
Collapse
Affiliation(s)
- Paul Forsyth
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lynsey Moir
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Iain Speirits
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Steve McGlynn
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Margaret Ryan
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Anne Watson
- Pharmacy, NHS Education for Scotland, Glasgow, UK
| | - Fiona Reid
- Pharmacy, NHS Education for Scotland, Glasgow, UK
| | | | - Clare Murphy
- Cardiology, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| |
Collapse
|
17
|
Ventura M, Belleudi V, Sciattella P, Di Domenicantonio R, Di Martino M, Agabiti N, Davoli M, Fusco D. High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. PLoS One 2019; 14:e0212398. [PMID: 30785928 PMCID: PMC6382131 DOI: 10.1371/journal.pone.0212398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 02/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background The relationship between guideline adherence and outcomes in patients with acute myocardial infarction (AMI) has been widely investigated considering the emergency, acute, post-acute phases separately, but the effectiveness of the whole care process is not known. Aim The study aim was to evaluate the effect of the multicomponent continuum of care on 1-year survival after AMI. Methods We conducted a cohort study selecting all incident cases of AMI from health information systems during 2011–2014 in the Lazio region. Patients’ clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. For each subject the probability to reach the hospital and the conditional probabilities to survive to 30 days from admission and to 31–365 days post discharge were estimated through multivariate logistic models. The 1-year survival probability was calculated as the product of the three probabilities. Quality of care indicators were identified in terms of emergency timeliness (time between residence and the nearest hospital), hospital performance in treatment of acute phase (number/timeliness of PCI on STEMI) and drug therapy in post-acute phase (number of drugs among antiplatelet, β-blockers, ACE inhibitors/ARBs, statins). The 1-year survival Probability Ratio (PR) and its Bootstrap Confidence Intervals (BCI) between who were exposed to the highest level of quality of care (timeliness<10', hospitalization in high performance hospital, complete drug therapy) and who exposed to the worst (timeliness≥10', hospitalization in low performance hospital, suboptimal drug therapy) were calculated for a mean-severity patient and varying gender and age. PRs for patients with diabetes and COPD were also evaluated. Results We identified 38,517 incident cases of AMI. The out-of-hospital mortality was 27.6%. Among the people arrived in hospital, 42.9% had a hospitalization for STEMI with 11.1% of mortality in acute phase and 5.4% in post-acute phase. For a mean-severity patient the PR was 1.19 (BCI 1.14–1.24). The ratio did not change by gender, while it moved from 1.06 (BCI 1.05–1.08) for age<65 years to 1.62 (BCI 1.45–1.80) for age >85 years. For patients with diabetes and COPD a slight increase in PRs was also observed. Conclusions The 1-year survival probability post AMI depends strongly on the quality of the whole multicomponent continuum of care. Improving the performance in the different phases, taking into account the relationship among these, can lead to considerable saving of lives, in particular for the elderly and for subjects with chronic diseases.
Collapse
Affiliation(s)
- Martina Ventura
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Paolo Sciattella
- Department of Statistical Sciences, “Sapienza” University of Rome, Rome, Italy
| | | | - Mirko Di Martino
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
- * E-mail:
| | - Marina Davoli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| |
Collapse
|
18
|
Albuquerque NLSD, Oliveira ASSD, Silva JMD, Araújo TLD. Association between follow-up in health services and antihypertensive medication adherence. Rev Bras Enferm 2018; 71:3006-3012. [PMID: 30517405 DOI: 10.1590/0034-7167-2018-0087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/01/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the association between the characteristics of follow-up in health services and adherence to antihypertensive medication in patients with cardiovascular disease. METHOD Analytical study carried out with 270 patients suffering from hypertension and hospitalized due to cardiovascular complications. Data collection occurred between November 2015 and April 2016, involving sociodemographic variables, presence of self-reported diabetes, accessibility and use of health services, blood pressure levels and medication adherence (analyzed through the Morisky-Green Test). RESULTS The rate of adherence to antihypertensive therapy was 63.0%. Enrollment in the Hiperdia program had no statistical significance to medication adherence. People who attended at least between 4 and 6 nursing consultations throughout the data collection period (p = 0.02) had better adherence. CONCLUSION The study's findings provide support for the reorientation of health services and their public policies towards improving adherence to antihypertensive therapeutics.
Collapse
|
19
|
The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand? Drug Saf 2018; 42:347-363. [DOI: 10.1007/s40264-018-0732-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
20
|
Milinkovic I, Ašanin M, Simeunovic DS, Seferović PM. In the search for an ideal registry: Does the cloud have a silver lining? Eur J Prev Cardiol 2018; 25:956-959. [DOI: 10.1177/2047487318774420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Milika Ašanin
- Clinical Center of Serbia, Serbia
- University of Belgrade School of Medicine, Serbia
| | - Dejan S Simeunovic
- Clinical Center of Serbia, Serbia
- University of Belgrade School of Medicine, Serbia
| | - Petar M Seferović
- Clinical Center of Serbia, Serbia
- University of Belgrade School of Medicine, Serbia
| |
Collapse
|
21
|
Anderson TS, Lo-Ciganic WH, Gellad WF, Zhang R, Huskamp HA, Choudhry NK, Chang CCH, Richards-Shubik S, Guclu H, Jones B, Donohue JM. Patterns and predictors of physician adoption of new cardiovascular drugs. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2017; 6:33-40. [PMID: 29066168 DOI: 10.1016/j.hjdsi.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about physicians' approaches to adopting new cardiovascular drugs and how adoption varies between drugs of differing novelty. METHODS Using data on dispensed prescriptions from IMS Health's Xponent™ database, we created a cohort of all primary care physicians (PCPs) and cardiologists in Pennsylvania who regularly prescribed anticoagulants, antihypertensives and statins from 2007 to 2011. We examined prescribing of three new cardiovascular drugs of differing novelty: dabigatran, aliskiren and pitavastatin. Outcomes were rapid adoption of each new drug, defined by early and sustained monthly prescribing detected by group-based trajectory models, by physicians within the first 15 months of marketplace introduction. RESULTS 5953 physicians regularly prescribed each drug class. The majority of physicians (63.8%) adopted zero new drugs in the first 15 months, 35.0% rapidly adopted one or two, and 1.2% rapidly adopted all three. Physicians were more likely to rapidly adopt the most novel drug, dabigatran (27.3%), than aliskiren (10.5%) or pitavastatin (8.0%). Physician specialty and sex were the most consistent predictors of adoption. Compared to PCPs, cardiologists were more likely to rapidly adopt dabigatran (Adjusted Odds Ratio 8.90, 95% confidence interval 7.42-10.67; P<0.001) aliskerin (2.05, CI 1.56-2.69; P<0.001) and pitavastatin (3.44, CI 2.60-4.57; P<0.001). Female physicians were less likely to adopt dabigatran (0.71, CI 0.59-0.85; P <0.001) and aliskiren (0.64, CI 0.49-0.83; P <0.001). CONCLUSIONS Physicians vary in their prescribing of recently-introduced cardiovascular drugs. Though most physicians did not rapidly adopt any new cardiovascular drugs, drug novelty and cardiology training were associated with greater adoption.
Collapse
Affiliation(s)
- Timothy S Anderson
- Division of General Internal Medicine, University of California, San Francisco, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmacy, Practice and Science, College of Pharmacy University of Arizona, USA
| | - Walid F Gellad
- Division of General Internal Medicine at University of Pittsburgh School of Medicine; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, USA
| | - Rouxin Zhang
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Crabtree Hall A613, Pittsburgh, PA 15261, USA
| | | | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics and Center for Healthcare Deliver Sciences, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Chung-Chou H Chang
- Division of General Internal Medicine at University of Pittsburgh School of Medicine, USA
| | | | - Hasan Guclu
- Department of Statistics, School of Engineering and Natural Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bobby Jones
- Department of Psychiatry, University of Pittsburgh Medical Center, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Crabtree Hall A613, Pittsburgh, PA 15261, USA.
| |
Collapse
|
22
|
Ganasegeran K, Rashid A. The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia. Patient Prefer Adherence 2017; 11:1975-1985. [PMID: 29263654 PMCID: PMC5726356 DOI: 10.2147/ppa.s151053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although evidence-based practice has shown the benefits of prescribed cardioprotective drugs in post-myocardial infarction (MI) survivors, adherence rates remain suboptimal. The aim of this study was to determine the prevalence and factors associated with medication nonadherence among post-MI survivors in Malaysia. MATERIALS AND METHODS This cross-sectional study was conducted from February to September 2016 among 242 post-MI survivors aged 24-96 years at the cardiology outpatient clinic in a Malaysian cardiac specialist center. The study utilized an interviewer-administered questionnaire that consisted of items adapted and modified from the validated Simplified Medication Adherence Questionnaire, sociodemographics, health factors, perceived barriers, and novel psychological attributes, which employed the modified Confusion, Hubbub, and Order Scale and the Verbal Denial in Myocardial Infarction questionnaire. RESULTS The prevalence of medication nonadherence was 74%. In the multivariable model, denial of illness (AOR 1.2, 95% CI 0.9-1.8; P=0.032), preference to traditional medicine (AOR 8.7, 95% CI 1.1-31.7; P=0.044), lack of information about illness (AOR 3.3, 95% CI 1.1-10.6; P=0.045), fear of side effects (AOR 6.4, 95% CI 2.5-16.6; P<0.001), and complex regimen (AOR 5.2, 95% CI 1.9-14.2; P=0.001) were statistically significant variables associated with medication nonadherence. CONCLUSION The relatively higher medication-nonadherence rate in this study was associated with patient-, provider-, and therapy-related factors and the novel psychological attribute denial of illness. Future research should explore these factors using robust methodological techniques to determine temporality among these factors.
Collapse
Affiliation(s)
- Kurubaran Ganasegeran
- Department of Public Health Medicine, Penang Medical College, George Town, Malaysia
- Correspondence: Kurubaran Ganasegeran, Department of Public Health Medicine, Penang Medical College, Sepoy Lines, George Town, Penang 10450, Malaysia, Tel +60 19 371 1268, Email
| | - Abdul Rashid
- Department of Public Health Medicine, Penang Medical College, George Town, Malaysia
| |
Collapse
|